Provider Demographics
NPI:1780822270
Name:FISHER, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3595
Mailing Address - Country:US
Mailing Address - Phone:630-455-4545
Mailing Address - Fax:
Practice Address - Street 1:930 N YORK RD STE 100
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3595
Practice Address - Country:US
Practice Address - Phone:630-455-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor